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HomeMy WebLinkAbout0616 HUCKINS NECK ROAD - Health 61-6 Hucktns-Pteck,Road'-- Centerville A = 234 074 4�' I s <LCommonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE � MA 02632 11-7-17 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Bk0° Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-7-17 pect ignatuW Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 41 vS f ' Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM ,. 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. THIS REPORT CAN NOT DETERMINE THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USAGE.THIS REPORT IS NOT TO BE USED FOR BEDROOM DETERMINATION. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced • ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y P Y � p rY� coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified' laboratory,for fecal coliform bacteria indicates absent and the presence' of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two'weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 2 COMP TANK, D-BOX, AND 2 500 GALLON LEACH CHAMBERS WITH 4 FT OF STONE. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d N.A 9 ( Y 9 (gP ))� Detail: TYPED REPORT AFTER HOURS SO READING WERE NO AVAILABLE. THERE HAS ONLY BEEN ONE PERSON LIVING AT THE PROPERTY FOR QUITE SOME TIME. Sump pump? ❑ Yes ❑ No Last date of occupancy: currentlyoccupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Scott frank pumped at time of inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: first compartment for maintenance gallons How was quantity pumped determined? Reason for pumping: maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2012 attached permit Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: moderate in first compartment t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped at time of inspection for maintenance. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box was functioning properly at time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There were no signs of failure or overload in chambers at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: none encountered at time of perc feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 616 HUCKINS NECK RD Property Address LARRY NICKULAS Owner Owner's Name information is required for CENTERVILLE MA 02632 11-7-17 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable Regulatory Services Thomas F.Geiler,Director MAM l ►.�. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 - Fax: 508-790-6304 Date: ®Cr -;4, 20/Z Sewage Permit#ZO/L' Z 5� Assessor's Map/Parcel 2-3 ' 7�4 Installer& Designer Certification Form Designer: .7, -A�yL� �S s°c/fl?"E3 Installer: G ��y ,1/iGk�A�n�_5 Address: /7° G�UVE�C'F�E�� u�A� Address: 6� ��-� �'D 7 On /0 /i- 2D/2. 1_19�0kl A11C t tIZAS was issued a permit to install a (date) (installer) septic system at �/� ��yG %�/5 /!/ G/� �c'� based on a design drawn by (address) X72-5 dated S&PT Z. 3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 7 I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Re rulations. Plan revision or certified as-built by designer to follow. Stripout(if req ' ected and the soils were found satisfactory. ,a�`j F M,40. ►�^` R aG (Installer's Signature} `"No. 1140 j;r , t �` /STERN 1 NITARIN (If)eIsigner's,Signature). (Affix Des mp Here) Vw PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc V T i . 1 -T/OWN OF BARNSTABLE LOCATION&f,(, /�uG�/CIS Wens f SEWAGE# �� KZA"?Zls VILLAGE- C�h ASSESSOR'S MAP&PARCEL -77 ! INSTALLER'S NAME&PHONE NO. ?6,? SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) roof � NO.OF BEDROOMS k OWNER ,I-cf c z a/e ` PERMIT DATE: 16111 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on ,A/ site or within 200 feet of leaching facility) 00 /61 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) Feet FURNISHED BY �f �� �'.� 1 '4] ---- ----- -- -- - ------------------------------ -------.._..---- -- •- --------- ------•--- No. FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstetn Construction Permit Permission is hereby granted to Construct Repair( ) Upgrade( ) Abandon( ) j System located at -IV-ec A 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. r` Date o I// Z Approved by �► o L� ez"yi� � R.A 4 a. V TOWN OF BARNSTABLE LOCATIO)t Z_-o ,sN r4&-D1Aeg1*A3 SEWAGE # VILLAGE ( �t/, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE-NO. �+i iLG7ar co use SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size)_ acy-6 NO. OF BEDRLWN PRIVATE WELL OR UBLIC WATE �PER IJiC Ky Lam• DATE PERMIT ISSUED: Ay DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 �� �r �..--- --,, „� �� ,'d`� i� �l` f L \'�� � �l � `. �� � b ..,� ...� ���� �.�. ��_. Fe:11/ 0 THE COMM LTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION NN OF BARNSTABLE, MASSACHUSETTS ftplitation for Misposai *pstrm Construction Vermit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components L cat'on Address or Lot No. (o l& / uclZjns /JAG k Owner's Name,Address,and Tel No. C e­r y/-- Assessor's Map/Parcel Z-3 y 2 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. � /2S �OX A5�7� /F j 7C) C to v e.—f,-e 160 4� Type of Building: Dwelling No.of Bedrooms Lot Size / S 3 sq.ft. Garbage Grinder( ) Other Type of Building ��S. No.of Persons Z Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �/(! ��� gpd Design flow provided gpd Plan Date ?/Z 3/l Z Number of sheets ` Revision Date Title S% e LJ Gt q e Fy i" Size of Septic Tank /�(�(C(U Type of S.A.S. Description of Soil @'� "' g a �� /_cs"t.+� ""2 y S i"Z Z,0 ,n Z�` - 7�• 37 y y `� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date C Application Approved b Date l� / Application Disapprov y Date for the following reasons Permit No.Zo 17- —!2P 7 Date Issued ; . Ll No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 4 PUBLIC HEALTH DIVISIOf -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for ]Disposal 6pstem (Construction 3permit t Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. (p/� /4/UG 1c14 S ^/eC k Owner's Name,Address,and Tel No. -� Assor's P� 3 V �.GI, r1. 1/ x sv / v �� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. /YUX S"L� �— /.� 7- n i t 7r U G Type of Building: C�/�"(j to 4-,16(s (� Dwelling No.of Bedrooms Lot Size 7 3 sq.ft. Garbage Grinder( ) Other Type of Building� e S. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min:required) /6 /3 I'/! gpd Design flow provided 3 gpd Plan Date q�� Number of sheets Revision Date Title Si c tC e"n q.r -far- 4p-o rY �j,AS Size of Septic Tank /�n a Type of S.A.S. r Description of Soil -� _ a y«� _2 9 p ,' Zz 7 COS Nature of Repairs or Alterations Answer when applicable) . ( PP ) Date last inspected: Agreement: "A The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. I Si ed ��4e -� Date /,6 Application Approved b Date Application Disapprov y Date for the following reasons Permit No.�01: — 5,7 Date Issued /0�tr o C72 --------------------------------------------------------------------------------------------------------------------------------------- TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 1 , (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposals stem Constructed( Repaired( ) Upgraded( ) Abandoned( )by Z rd r_r- i c ,-( J at & I!n � -lam has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7.0 L ' 3ZS dated 10'0 701-L- InstallerC /�/, (��//�// ) Designer37 /���( #bedrooms, `z Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system-wil'1`fimetion designed. Date �� !� ,� Inspect(© --------------------------------------------------------------------------------------------------------------------------------------- No./ I—Z / Fee /�0 ov THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct(K) Repair( ) Upgrade( ) Abandon( ) System located at C_ // ,�.P(^ —e-e-z -71 I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit./ ) I Date /��'c�i 7 Approved by i 1 Town of Barnstable Regulatory Services 'brN• Thomas F.Geiler,Director Public Health Division ►`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: ®cr 3b 22 0/Z Sewage Permit#20/7-"3 23- Assessor's Map/Parcel Installer& Designer Certification Form Designer: .T-4 d YL 4c ,9s�so c/.9TE3' Installer: Z#Ze y Address: /70 �LoVE,�F/E4� G�A� Address: �/0:ei ---l/9�L D Z to G'F On /6-//- 2 D/Z. L 1,.fXl /Ulc&IIZAS was issued a permit to install a (date) (installer) septic system at el.-/&I IW4,^k/l/s /1 rCA' 44Ab based on a design drawn by (address) 14 -00IZ-9 /9`-rra c-l DfTES' dated 5&�°T 2 3 Z d l Z (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Re ulations. Plan revision or certified as-built by designer to follow. Stripout(if req ' ected and the soils w e found sfactory. ��0 F MAss� D R E cyGN R ( sta ler's ignature) . 1140 V 1 V ll STER�C I l gbli'ARlP, esignW s ignature) (Affix Des p Here) PLEASE RTURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice forms\designercertification form.doc TOWN OF BARNSTABLE �'� UJCATION 016 1t�f WeCk &SEWAGE# Zffl Z -,?Z VILLAGE ASSESSOR'S MAP/&PARCELOde' INSTALLER'S NAME&PHONE NO.Z-A/'/yA/k j SEPTIC TANK CAPACITY w LEACHING FACILITY:(type) �'IG�„�-rd��� (size) U� NO.OF BEDROOMS OWNER CJ�C� PERMIT DATE: / T��-L, COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) AP/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYd�/� ®7 � Zy332 g'3 39' 06, /y S-7 9 C. Town of Barnstable . P# C "' Department of Regulatory Services enarrar.�ern Public Health Division Date MARS. r16 39.��� 200 Main Street,Hyannis MA 02601 Date Scheduled / / Time ! Fee Pd. Soil Suitability Assessment for S e Disposal Performed By: Witnessed By: LOCATION& GE /� INFORMATION f Location Address // - J� f, Owner's Name / c3 tr Q � M Address er�''X C �y Assessor's Map/Parcel: �� Engineer's Name :! jj�;� NEW CONSTRUCTION REPAIR Telephone# J 6 3 Land Use�Z6T _ Slopes(96) IJ Surface Stones AA91 6 j.Tz5;ekf�'m Distances from: Open Water Body �✓r0 ft Possible Wet Area l�U ft Drinking Water Well ft Drainage Way DSO ft Property Line !19 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands fln proximity to holes) Sep s7 o i 2 _® b3- - Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /UaN Weeping from Pit Face Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: In. Depth to sell mottles: Depth to weeping from side of obs.hole: In, Groundwater Adjustment f. Index Well# Reading Date: Index Well level__:_ Adj,(Actor- Adj.Groundwater level, PERCOLATION TESL' DIAZAWI �e o �1 t'�1 Observation ' Hole# 7P-1 Z�'-3_ Time at9" « K Depth of Perc 30 Z Time at 6" Start Pre-soak 7ttrue @ ��.4 P 3 b 119i l 9 20 Time(9"-6") End Pre-soak Z it COy- 1P!/6, d /0r I: r0 Rate Min./Inch `` 2- L Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:%SEPTIC\PERCPORM.DOC r DEEP.OBSERVATION HOLE LOG Hole# Z _ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, o i ten!y,%'Gravel) 2,s / y ZQ -17 C Co 73-M V9 All m,l�GtGJ ' DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.1 Gravel) S Vo-� Z•S &O 3-3 �- z � �• . s��T�a�� �syQ�r -/3 k C Gs /a1A 7/ DEEP OBSERVATION HOLE LOG Hole,# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling ' (Structure,Stones,Boulders. Consistency, Gravel) a /o S y z,s� � 1111-a44,r�� Al GD/146 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi t n T 4a,41`1 7,S/q 2 3 7 1014 ,SY/1 7 8 37 -J3 z. G c oil sc /� Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No--1/— Yes Within 100 year flood boundary No.--L/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? - je at is he depth of natural] occurring pervious material? If not,what t p y g Certification I certify that on 9J (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 110 CMR 15.017. Signature Date QAS.EPTIC1PERC17ORM.DOC Health Complaints 02�Jul-03 Time: Date: Complaint Number: 4134 Referred To: DONALD DESMARAIS Taken By: RITA Complaint-Type: ILLEGAL HOUSING Article X Detail: Business Name: Number: 616 Street: HUCKINNECK ROAD Village: CENTERVILLE Assessors Map Parcel: Address: SAME Telephone Number: NONE (PO #189 - PINEHU Complaint Description: SHE RENTS THE APPT OVER GARAGE AT #616 FOR$600. PER MO.AND THERE IS ONLY ONE ENTRANCE. IF MAIL MISTAKENLY GOES TO 616 INSTEAD OF HER PO IT IS WITHELD BY LANDLORD. SHE HAS ALSO HAD TO LEAVE FOR SAFETY SAKE DURING AN EPISODE OF HER PRIVACY BEING INVADED.. Actions Taken/Results: Put call (7/1/2003) in to owner of property to ascertain what is going on. Mr. Nickulas called at 8:20 AM 7/2/2003. He assured me that there is.no power or water in the garage/shed where the woman said she was living. I saw that he did have an extension cord running from the main house to the shed. No furthur action Investigation Date: 7/1/03 Investigation Time: 11:00:00 AM 1 Fie v4 A Cyne- cl Y,3 663 P 6AL y tOr s � � �� qS N )Q-ko �CO5 wo ? , tic- M(! �� (S mc:�IL 0- \R--Rte(O l )n z T2 C3 f j 1C AS 6V IA3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map L- Parcel / _ ' Permit#3 Ac 0- Health Division -- `I �1� -/v� r��'�✓ �� Epate Issued U 3 Conservation Division dT to t Application Fee 00 L. F Tax Collector } j Permit Fee J2 Treasurer - Planning Dept. / lJ t� _ WTH TITLE 5 Date Definitive Plan Approvari by Planning Board I ENVIRONMENTAL CODE ANG Historic-OKH Preservation/Hyannis r-- TOM REGULAn- ONS Project Street Address tIOZ& -(-'-' , ,- Village Coc- 46 Owner /l C f Address _ cj A S<� ci Telephone 47 C _ ( �� 4--1 0' o,z �JlC 6_/� Permit Request � Square feet: 1st floor: existing- Proposed /CI 2nd floor: existing zo h proposed -Z-0 Total new=Ot ZoningDistrict f <Flood Plain et A Groundwater Overlay )Zee Project Valuation l �G P Construction Type 6_% Lot Size Grandfathered: Nes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: CI Yes .Cl0 On Old King's Highway: ❑Yes �No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) ilX r /? fC .Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new --- D Half: existing T Cf new ' C/ Number of Bedrooms: existing_ new _ C� _ Total Room Count (not including baths): existing 9 new C( First Floor Room Count Heat Type and Fuel: �7Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing _ New Existing wood/coat stove: ❑Yes o Detached garage?existing ❑new size Pool: ❑existing ❑new size Barn: ❑existing ❑new size Attached garage776pisting new size `'� Shed:0 existing ❑new size Q Other: Zoning Board of Appeals Authorization ❑ Appeal # _ Recorded Li Commercial ❑Yes o If yes, site plan review# Current Use �c,, , z--� Proposed Use �" `� 11U LDER INFORMATIONp Name E'` /C- l fM/ Telephone Number f Address �/_ / '/ License# ��/C Cf Home Improvement Contractor# Z � L- Worker's Compensation # S c, z /q C ,Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO //Jc" �G SIGNATURE Z"2 DATE C% No.... -� F�s.......... d:f�... THE COMMONWEALTH OF MASSACHUSETTS � 757S'o IV.,,° ;4 r AR® Off` HEALTH ,� ��1 .._.................f oF........: . . ---.----------------------- � ,� lirFation for Dig og al ors Clay ��� � k n trnrttun ramit ttnn'' �- U v CC'Application is hereby made for a Permit to Construct (4) or Repair ( ) an Individual Sewage Disposal System at: IVLo 'on-Ad re - _ Owner Address Installer ...----•--•--.....-'--•-•---•^---•----.... � Address Type of Building Size Lot.._.4:��__L 00...Sq. feet Dwelling—No. of Bedrooms........ ...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------•-•-•-•----------------------•----••••••-• ---•••••-•----------•---•........••---•------------•--••------•-•••••......---•••-•••-••-••••- �p gallons per person per day. Total daily flow...... ........... .....gallons. W Design Flow----1��---/-�+��/�==--------- - ....... WSeptic Tank—Liquid capacity/S0A.gallons Length Width.._ `' Diameter................ Depth... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......�_.__.. Diameter.._..f.Lt..__.____ Depth below inlet...... ....... Total leaching area..Zf.511...sq. ft. Z Other bution box tank (�) y---g ( ) - � 6�r'C? a Percolation TestResults Performed bsmZc� _ .. 2 ,�. .............. Date_..... ..... .._1................_. Test Pit No. 1---5_2-...minutes per inch Depth of Test Pit....,/-Z..._._... Depth to ground water_.Al ..�.' , fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' •----------------------•-------- ••-••••-••-••--a-------------......... ....... Description of Soil..............0.._Z...._. ?`,, �?f� x --------------------------•--------••--------------------------------.....-•-.------ -71-- G - - �� � ------------------------------------------------------------------------------------- x -------------------------------------------7 `A)----f/N .S N, ------ V Nature of'Repairs or Alterations—Answer when applicable_________________________________________________________________________________-..-_-__. -----------------------------------••. -----------------------------•--------------._......---------------••---------------------------------------------------------------------..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in cordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board o iealth. Signed------ ------.�......'.�.,:Y ............................ ................................ Date Application Approved By... (� .... ..........V. Date Application Disapproved for the following reasons:............................................................................................ .................. -------------------------------•---.....--------•----------------.._..------------------------------------------------------------... Date Permit No.----•.71J..:.__..�.-`-3 .................••• Issued........................................... to...... Date No....7 /�3 3 FimB......... 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............................. .....................................................*------------------- ...... Appliration for Raposal Vorko Tonstrurtion ramit Application is hereby made for a Permit to Construct 4) or Repair an Individual Sewage Disposal System at: ......................................................... ---------------------------- 7------------------------------------------------------------------------------------------------ Location Address or,, 'e.</-r ................................................................................................. ................................... ..................*----------------------------------------- owner Address .................................................................................................. .................................................................................................. Installer Address Type of Building Size Lot... t ----A -.` _._Sq. feet U ---0- Dwelling—No. of Bedrooms___....,.3--------------------------------Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtVres ...................................................................................................................................................... t(l .-V W Design Flow....J.I...... �..........gallons per person per day. Total daily flow_-__-_ .........................gallons. 0� Septic Tank—Liquid'capacity/.'-�'�-�."4,�..gallons Length.A2.'.�'_.1. Width...5..C�_." Diameter................ Depth...--5". Disposal Trench—No. .................... Width....._........._._.. Total Length__.................. Total leaching area--------------------sq. f t. " "V"` Seepage Pit No... Diameter..... ..... Depth below inlet......_4............. Total leaching area..., /-.-.-sq. ft. Z Other Distribution box ( I) Dosing tank Performed by__A'._� V1 -7 .............. Date.... ....................... Percolation Test Results C.7 z "k,24- .��­­ ­ ��'q ----------- ......... Test Pit No. I..`..:....minutes per inch Depth of Test Pit..._/.Z......... Depth to ground water.A Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..____............._.._. P4 ................................ ...........;­ --------**--------- 0 Description of Soil.............. ---7 .......... --- ............ -------- --*------ -------------------------------------------------------------------------------------------­......- .............................................................................. .................................................................................................... U ...........................................7...... ----------- �1 ......................... ....................................................................................................... U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------- ................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT TLE4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has hgcp issued by the board of health ........................................... ................................ Date Application Approved By........ ......................... ......... ---------- _7_ Date '" Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo-------7.1y..- ------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I...........................OF..................................................................(Intifikate of Tontpliaurr THIS IS CE#TIFY, That the Ind;vU*' ual Sewage Disposal System constructed or Repaired by...................... ...SA-ca ............. ................................................................................................................. L I taller er at................. ........7 .......... ........ ............... . ....../........................ ...........k 4 ............................ ............ ...................... has been installed in accordance with the provisions of TITZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nc dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........OF.......... ................................. ... N FEE.................--..... Dispaoal Works Tonotrurtw- n "V t 4, Permission is hereby granted.............4.�. 7.. k�4_5 ..= ................ ........ .....s5................ . ..... to Construct or Repair an Individuaj�Sewage Disposal System at No......... ------j _,Patli ................................................................................ Street 7y,83 as shown on the application for Disposal Works Construction Permit --- ------- Dated.......................................... ...........................I.-- *d'-o'f_Health' -----***------------------*-------------— Boar DATE-------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS f 20'-T EXIST. 43'-r 4'1r �.� DECK UP FAMILY --------- APARTMENT--F 34 I -1 J XIST. I I I I I i I S M u DRo6 P I I I I I I I r- ---_ L_LIJJJ y. i r� {' { �W'(7_1_i_I _—— ANDERSEN _ _�iALI.---- /REMOVE EXFILIST.STAIRS �y ——— 2446 --_ TO MAT HEMS FLOOR EXIST. -7"-_T— TO MATCH EXISTIFJG JOISTSIZE GARAGE OPEN N STORAGE -- N A3 1 a EXIST. EXIST. --- EXIST. EXIST. O L'DRY. GARAGE 4� N W POSTS 4 BEDROOM GARAGE O CLOS SEXIST. KITCHEN __ CLOS.__ CLOS t? OF ON. 7'41• 30'-,, i f FIRST FLOOR FLAN r LEGEND: § 0 EXISTING WALLS EXIST. �- CONSTRUCTION TO BE REMOVED L--J LIVING RM NEW CONSTRUCTION EXIST. DINING EXIST.GARAGE =725 S.F. EXIST.FIRST FLOOR =1025 S.F. EXIST.SECOND FLOOR =513 S.F. TOTAL FINISHED SPACE =2263 S.F. FAMILY APARTMENT =798 S.F. 26'-Q PRELIUikaJARY DRAWING FOR DESIGN REVIEW h¢DESIORO OMISSNER5HALIONS ANY SCALE : DRAIMNG NO. : ERRORS OR OMISSIONS ARE FOUND ON Q COTUIT BAY DESIGN, LLC NEW ADDITION FOR: MMTRRAV.ING<_PPoORTOSTARTOF CONSTRUCTION THE SU R TH CONTRACTCJt 11411 - 1 1-0'1 WILL BE RESPONSIBLE FOR THE CONTENT IN WERE ES%MT OS IF CONSTRUCNON 43 BREWSTER ROAD COMMENCES VNT OVT NO F-CMI' DESIGNER OF ANY ERRORS OR Cfl.!%&DNS. MAS H P E E ,MA. 02649 N I C K U LAS RESIDENCE THESE DRAW=8 ARE EOLELY FOR YiL USE DATE PH. (508) 274-1166 THESE THE OWNER NOTEO.ANY OTHER USE nF FAX (508) 539-9402 616 HUCKINS NECK ROAD CENTERVILLE, MA THEEEESS0.DPAW EREORIml" T--_ 10/2/2012 Al CONSENT OF TFE OE v!.�R U\L'R T-, ARCHITECTURAL COPY"' Or"' PROF_^CN ACT OF i95fJ. -—-—-— �____—_—_---_—_—_ 3T-10' _—_—____—_---_--- 41,E y — 1 FAMILY APARTMENT b 1 N I i E I i �' I FD7 S ROOF BELOW i 1 r � I NEW KITCHEN I ANDERSEN f I o 0 EXIST. - Z�z --- EXIST. BEDROOMLX6 t ct LIVINGO A3 ' II 4 0-7-17-7 ANDERSENEXIST. EXIST. "" ' BATH BATH CLOS. 1 CLOS. I EXIST. LOFT I I 4 ON. I 1 ---- ---------------------------------------- EXIST. SECOND FLOOR PLAN I BEDROOM I ' I I I PRELIMINARY DRAWING FOR DESIGN REVIEW THE DESIGNER MUSSISH4L BE MARNOTIFIED h ANY SCALE : DRAWING NO.: ERRORS OR OMISSIONS PRE:`•JFL ON Q COTIJIT BAY DESIGN, LLC NEW ADDITION FOR: CONSTRUCTION. THE R TO LDINGSTARTC .. CONSTRUCTION.THE BUILDING TH CCNDiACiOR 1/411 = 11-0" 43 BREWSTER ROAD IN THESE RAWNSPONS SILE F ONSTRU.J�ON IN THESE ES V19T O IF CO IFYIN3 THE MASHPEE ,MA. 02649 N I C KU LAS RESIDENCE THESCOMMENCES WITHOUT OLELYI FOR THE DESIGNER OF ANY ERRORS OR OLVSSOAIS. PH. (508)) 274-1166 OF OVA ER NOTED,S ARE NYOTHEUSEOFE DATEA/. FAX (508} 539-9402 OF HE ONOF TNOTED AN OTHER USE of 616 HUCKINS NECK ROAD CENTERVILLE, NIA THESE DRAMNTHEOS REWIRES THE WR TEN CON IT.1UR.CD1RI-SIGNERHf .1 10/2/2012 AC?OF 199D. ,r 12 NEW ASPHALT ROOF EXIST. SHINGLES TO MATCH 12 EXISTING u EXIST.p t _ Z NEW RAKE BOARDS y TO MATCH EXISTING 12 k 2 NE1M1/FASCIA,FRIEZE 8 SOFF!T BOARDS TO MIATCH EXISTING z U Si r Q ' NEW W.C.SHINGLE ® SIDING MATCH EXISTING OPEN z STOR. s NEW CORNER BOARDS E N TO MATCH EXISTING OD L i SIDE ELEVATION FRONT ELEVATION REAR ELEVATION 4'1T UP 2-2xlOBFAM E b NEW ROOF CONST. V 4 � -2 x 10 ROOF RAFTERS a 16'o.e. .�----� •5/S'COX PLYWOOD ROOF SHEATHING ,I -ASPHALT ROOF SHINGLES j ` -151.8.FELT PAPER I I -2 x 12 RIDGE BOARD •SIMPSON H 2.5 HURRICANE CLIPS AT ALL RAFTER ENDS -ICE/WATER SHIELD AT BOTTOM MY OF ROOF -PROP-A VENT BETWEEN RAFTERS ` —-1 I N STAIR •V WD WASH BARRIERS r —— 1 2x 12 RIDGEW/ h r P.T.2x6's@16'0.0. i --- P.T 2x6's�?E'DO. 3{ 2-2 x 10'9 A A b P.T.2 x 10 LEDGER BOARD LAG BOLTED TO f A3 v SOLID BLOCKING W/(2)LEDGERI.OK BOLTS 16"o.0 W/ZMAX JOISTS HANGERS , NEW WALL CONST. I I E? f 1 R 1.2 x 4 STUDS Q 1B'o.c. I N P.T.2 x 10 LEDGER BOARD LAG BOLTED TO I 2.112'PLYWOOD SHEATHING SOLID BLOCKING W/(2 LEDc3ERLDK BOLTS I STOR. 3.W.C.SHINGLE SIDING 16"0.c.W/ZMAX JOIST HANGERS I 4'-0" 4-TYPAR VAPOR BARRIER P.T.4 x 6 POSTS ON 12'DW CONCRETE SONOTUBES W/ P.T.4 x 6 POSTS A 24"DIA.CONCRETE BIGFOOT p, 0 FOOTINGS TO 4'0"BELOW - GRADE.USE SIMPSON ABU46 ZMAX POST BASE 6 LCE4 POST CAPS P.T.4 x 6 POSTS ON 12"DIA _ i E? CONCRETE SONOTUBES W/ Ib i 24'DIP,CONCRETE BIGFOOT j I FOOTINGS TO 47 BELOW GRADE.USE SIMPSON ASU46 fi ZMAX POST BASE&LCE4 POST CAPS i --------' A SECTION @ STAIRS - FRAING/FOOTING PLAN A3 ROOF FRA1�I�NG ALA .- - THE DESIGNER SHALL SE NOTIFIED IF ANY TFHSED OR RAA"NNGI9SMO TKOSTOAROP i SCALE DRAIMNG NO_: COTUIT BAY DESIGN, PLC NEW ADDITION FOR. 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